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Promoting safe pregnancy outcomes in the midst of malaria and COVID-19    

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Along the Nungua-Adogono road in the Greater Accra region is the LEKMA Polyclinic strategically positioned to serve various communities and individuals living within Nungua and other surrounding communities such as Spintex and Sakumono.

This health facility is not too far from the main Nungua market and the newly built transport terminal located near the Nungua Traditional Authority building.

This makes it possible for people from different backgrounds such as market women, commercial drivers, students and pupils from educational institutions such as the Nungua Senior High School to access basic health care at a public facility, without traveling outside the community.

This made it very convenient for Hannah Mills, a plantain seller at the Nungua market, to register for antenatal care (ANC) at the LEKMA Polyclinic when she was pregnant.

At this facility she was able to complete her three doses of the intermittent preventive treatment in pregnancy (IPTp). This involves drugs being administered to pregnant women under a direct observation treatment for protection against malaria.

An additional benefit that Hannah received at this facility was a free treated bed net for protection against mosquitoes, which is part of a package under a preventive strategy directed at pregnant women and children.

Although Hannah was able to deliver safely and now carries her son to the market to sell, she has never used the treated bed net given to her.

During an interaction with her, she said she dropped the net in the house without even unwrapping it.

In place of the net, her son sleeps in an untreated tiny net-like material carved in the form of an ark which is commonly sold in the market as part of baby care products. What this means is that this net may just drive away other insects from her son but not an infectious mosquito.

A smoked fish seller at the Nungua market, also nursing a baby said instead of sleeping under the treated bed net, she uses the fan in her room to keep mosquitoes away.

Adherence to treated bed net usage is not a habit that has caught on among some pregnant woman despite all the interventions being rolled out within communities and nationally.

Individual Responsibility

July 2, this year, saw the commemoration of the second anniversary of the Zero Malaria Starts with Me campaign, a pan-African movement targeted at strengthening national, regional and continental efforts towards a malaria-free Africa.

Co-led by the African Union Commission and the RBM Partnership to End Malaria, Zero Malaria Starts with Me is designed to ignite grassroots movements by engaging political leaders at all levels, mobilising resources and funding, and empowering communities to take ownership of malaria efforts and hold leaders accountable in the fight against malaria.

Since its launch by African leaders at the 31st African Union Summit in July 2018, the movement has been adopted in Ghana and 14 other countries (Chad, Cote d’Ivoire, Ethiopia, Eswatini, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Uganda, United Republic of Tanzania, Zambia, and some more countries are expected to follow this year.

A statement by the RBM Partnership to End Malaria to mark the second anniversary quoted World Health Organisation (WHO) sources and stated that severe disruptions to insecticide-treated net campaigns and access to antimalarial medicines as a result of the COVID-19 could lead to a doubling in the number of malaria deaths in sub-Saharan Africa this year.

“To avert this dire scenario, African nations are mobilising to use the critical window of opportunity ahead of the rainy season and before the further spread of COVID-19 across the continent to move ahead with life-saving mosquito net distribution campaigns, indoor residual spraying, and preventive treatments for pregnant women and children,” it added.

It is a plus that key organisations and various stakeholders are making effort to curb the upsurge in malaria cases during this period of the COVID-19.

It is especially important because the COVID-19 and malaria appear to share some team spirit. Both diseases present with febrile conditions, they are infectious and they come with significant public health implications.

More importantly, the prevention of the two diseases, to a large extent, involves individual actions or inactions and community mobilization to stay safe and to prevent infections by observing simple rules and changing one’s behaviour.

Urgent Task 

There is urgent business therefore to be undertaken by individuals such as pregnant women and other stakeholders within local communities to ensure that both malaria and the coronavirus disease do not overrun families and communities during this period.

For pregnant woman it is important that they are encouraged and properly educated to avoid carrying a double burden of being infected with both malaria and the COVID-19 by sticking to the rules, a public health specialist has said.

In an interview with ghanabusinessnews.com, Dr. Andy Ayim, a member of the Faculty of Public Health at the Ghana College of Physicians and Surgeons, said when pregnant women become infected with both malaria and the coronavirus diseases, the birth outcomes of these women could become a problem.

He said the best protection for these women is for them to adopt all the barrier methods aimed at prevention such as sleeping in treated bed nets, using facemasks, handwashing and social distancing so they stay safe from both diseases.

He noted that although sleeping under treated bed nets and wearing facemasks may bring along some discomfort to pregnant women, they need to be supported through risk communication to enable them appreciate the risks involved if they fail to use all the methods available to shield them and also offer protection for the unborn child.

Dr. Anim also advised that as soon these women show symptoms of the diseases, they should report early for medical assistance.

It is gratifying to note that health care to vulnerable groups such as children and pregnant women are still taking place despite the huge strain on resources brought about by the coronavirus pandemic.

During a visit to the LEKMA polyclinic, for instance, mothers and babies are still accessing health care with all the COVID-19 protocols in place.

The pandemic has also not impacted on ANC services at health facilities, for even small health facilities in rural areas such as the Peki-Adzokoe Health Centre and Abui Tsita CHPS compound in the South Dayi district of the Volta region.

Enquiries at both facilities by the ghanabusinessnews.com did show that everything is still normal and pregnant women are still showing up for ANC services.

The two facilities are also administering the IPTp and giving out free treated bed nets in the midst of the pandemic. A lot of education has also taken place to alert clients to make use of the COVID protocols for protection.

When the issue of pregnant women non-adherence to the usage of treated bed nets came up, it emerged that at the Abui-Tsita CHPS compound efforts had to be made to get more women to sleep under the nets after some of them had complained that the holes in the nets were too big and therefore mosquitoes could pass through them. They had also complained that the material used for the nets was too hard.

The facility therefore raised awareness that the treated nets have been dosed with drugs and therefore even if the holes were big, mosquitoes could not get in to bite.  Steps have now been taken and current nets are of softer materials.

The Abui-Tsita facility is now seeing a decrease in malaria cases among the pregnant women. Statistics are showing that out of every 10 pregnant women who walk into the facility, only two may have malaria when tests are conducted with the rapid diagnostic test kits.

The facility has also seen clients turning up in facemask after being educated and disabused of the notion that the virus is present only in Accra and not in the community.

A similar situation also played out at the Peki Adzokoe Health Centre when the usage of treated bed nets among pregnant women became a problem including the use of facemask.

The health personnel had to engage in community education and home visits to check if the treated nets are being used, which saw an improvement in the use of these nets. Also the sensitization programme on the COVID-19 has ensured that clients visiting the health facility are now donning on the facemasks for protection against the pandemic.

This has been supported by the local health committee at Adzokoe-Peki, made up of community members and health personnel who helped in the campaign for staying safe.

Additional support came in recently through an organization which suppled the health facility with facemask for clients who did not have the facemask.

With all these efforts being put in place within some of these local communities there is hope that vulnerable groups such as pregnant women would be spared from malaria and the COVID.

There is need, however, for health authorities to examine reasons why sleeping under treated bed nets is such a big issue for some of the women.

Almost all the women interviewed had different reason for non-adherence to bed net usage. Two young women with babies who were going for postnatal care popularly known as “weighing” at a centre near the Ravico Junction in Nungua gave two different reasons for disliking these nets.

For one of them, it had to do with the heat inside the net. The other women said she always has an unusual pain spreading around her face anytime she wakes up after sleeping under the net.

Whether these claims are true or false, it is important that steps are taken by the authorities to research and gather enough data so that provision can be made for more user-friendly treated bed nets.

This is important because the statistics on malaria in endemic countries are not too good and more needs to be done for vulnerable groups, such as pregnant women and children to keep them safe.

Leaving no one behind

Dr Tedros Adhanom Ghebreyesus, Director-General of the WHO, in the foreword of last year’s World Malaria Report, writing under the title: “Leaving no one behind in the march to a malaria-free world, noted that malaria in pregnancy compromises the mother’s health and puts her at greater risk of death.

He said it impacts on the health of the “fetus, leading to prematurity and low birthweight, major contributors to neonatal and infant mortality.”

According to him, last year, some 11 million pregnant women in sub-Saharan Africa were infected with malaria and, consequently, nearly 900,000 children were born with a low birthweight.”

“To protect pregnant women in Africa, WHO recommends the use of insecticide-treated mosquito nets (ITNs) and preventive antimalarial medicines,” he added.

He was mindful of the progress made, yet he noted that nearly 40% of pregnant woman did not sleep under an ITN in 2018 and two thirds did not receive the recommended three or more doses of preventive therapy.

The World Malaria Report pointed out that in 2018, prevalence of exposure to malaria infection in pregnancy was highest “in the West African sub region and Central Africa (each with 35%), followed by East and Southern Africa (20 per cent).”

More recently, the WHO’s modelling data has pointed out that severe disruptions to insecticide-treated net campaigns and access to antimalarial medicines as a result of COVID-19 could lead to a doubling in the number of malaria deaths – to nearly 800,000 – in sub-Saharan Africa this year.

It makes sense therefore that every effort is made to get everybody involved in the fight against malaria and COVID-19 by ensuring that no one is left behind, especially pregnant women and children.

By Eunice Menka
Copyright ©2020 by Creative Imaginations Publicity
All rights reserved. This article or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in reviews.

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